WO2009128810A1 - Appareil et procédé d’électrostimulation neuro-crânienne - Google Patents

Appareil et procédé d’électrostimulation neuro-crânienne Download PDF

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Publication number
WO2009128810A1
WO2009128810A1 PCT/US2008/010849 US2008010849W WO2009128810A1 WO 2009128810 A1 WO2009128810 A1 WO 2009128810A1 US 2008010849 W US2008010849 W US 2008010849W WO 2009128810 A1 WO2009128810 A1 WO 2009128810A1
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WIPO (PCT)
Prior art keywords
electrodes
electrode
task
current
stimulation
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PCT/US2008/010849
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English (en)
Inventor
Marom Bikson
Abhishek Datta
Fortunato Battaglia
Maged Elwassif
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Research Foundation Of The City University Of New York
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Priority to US12/937,950 priority Critical patent/US8718778B2/en
Publication of WO2009128810A1 publication Critical patent/WO2009128810A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0526—Head electrodes
    • A61N1/0529—Electrodes for brain stimulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36014—External stimulators, e.g. with patch electrodes
    • A61N1/36021—External stimulators, e.g. with patch electrodes for treatment of pain
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36014—External stimulators, e.g. with patch electrodes
    • A61N1/36025—External stimulators, e.g. with patch electrodes for treating a mental or cerebral condition

Definitions

  • the present invention generally relates to a method and an apparatus of electro-stimulation. Particularly, the present invention relates to a method of neurocranial electrostimulation.
  • Acute or plastic changes in brain function can be safely induced in humans by low-intensity electrical stimulation through scalp electrodes.
  • Such electrical stimulation is known as neurocranial electrostimulation (NCS) .
  • NCS neurocranial electrostimulation
  • Transcranial electrical stimulation conventionally refers to short-duration (50-500 ⁇ s) of supra-threshold pulses (100-1200 V).
  • Cranial electrotherapy stimulation utilizes a range of waveforms with peak current levels ranging from 50 ⁇ A to 5 mA.
  • Supra-threshold current pulse trains (about 0.9A) are generally used during electroconvulsive therapy (ECT) .
  • DC waveforms normally ranging from 260 ⁇ A to 2 mA are used for transcranial direct current stimulation (tDCS) .
  • NCS transcranial direct current stimulation
  • NCS is used in a broader sense to include any stimulation using an electrode on the head or cranium.
  • anodal stimulation enhances excitability
  • cathodal stimulation reduces excitability as has been shown in several studies.
  • Stimulation given to Ml can facilitate implicit learning and TES over the occiptal cortex can facilitate visuo- motor learning.
  • Stimulation has also been shown to alter excitability or resulting behavioral performance in somatosensory and frontopolar cortices.
  • Cranial stimulation is being explored as a non-invasive therapeutic option for the treatment of neurological and psychiatric disorders including depression, stroke, Alzheimer's, and learning disorders.
  • a critical limitation for cranial stimulation efficacy and safety is derived from the need for accurate control of exactly where in the brain the stimulation actually modulates the neuronal activity.
  • TES, and analogous Transcranial Direct Current Stimulation ("tDCS”) are considered to be poorly focused using common "remote bipolar" electrode configuration.
  • the present invention provides method and apparatus for neurocranial electrostimulation using electrodes, as further described below.
  • electrodes are located on the head or areas associated with the head of the subject, including the cranium, scalp, face, neck, ears, eyes, forehead, cheek, chin, nose, and mouth.
  • the following description shall be understood to apply to various of these embodiments, and therefore to various areas of the head. It will be appreciated that the invention is not limited by any illustrative embodiment described only with respect to one particular area of the head, such as the cranium.
  • a method for neurocranial electrostimulation includes - providing a first plurality of electrodes having at least one electrode; providing a second plurality of electrodes having at least two electrodes; locating the first and the second plurality of electrodes on cranium of a subject and supplying electric current of opposite polarities to the first and the second plurality of electrodes. Upon locating on cranium of a subject, at least one electrode of the first plurality of electrodes is surrounded by at least two electrodes of the second plurality of electrodes. According to a second aspect, there is provided another method for neurocranial electrostimulation.
  • the method includes - providing a first plurality of electrodes having at least one electrode; providing a second plurality of electrodes having at least one annular electrode having an opening; locating the first and the second plurality of electrodes on cranium of a subject; and supplying electric current of opposite polarities to the first and the second plurality of electrodes.
  • at least one electrode of the first plurality of electrodes is located within the opening of at least one annular electrode of the second plurality of electrodes.
  • an apparatus for neurocranial electrostimulation includes : a first plurality of electrodes having at least one electrode; a second plurality of electrodes having at least three electrodes; fixing means for locating the first and the second plurality of electrodes on cranium of a subject; and a source of electric current.
  • the source of electric current provides electric current of opposite polarities to the first and the second plurality of electrodes.
  • the first plurality is provided with positive polarity current while the second plurality is provided with negative polarity current.
  • a method of treating a human being suffering from a brain related ailment includes: providing a first plurality of electrodes; providing a second plurality of electrodes; locating the first and the second plurality of electrodes on cranium of a subject; and supplying electric current of opposite polarities to the first and the second electrodes .
  • at least one electrode of the first plurality of electrodes is surrounded by at least two electrodes of the second plurality of electrodes .
  • the number of electrodes and the location of the electrodes may be suitably selected depending up on the ailment.
  • a method of affecting human cognitive performance includes : providing a first plurality of electrodes; providing a second plurality of electrodes; locating the first and the second plurality of electrodes on cranium of a subject; and supplying electric current of opposite polarities to the first and the second electrodes, wherein at least one electrode of the first plurality of electrodes is surrounded by at least two electrodes of the second plurality of electrodes .
  • a method of modulating brain function includes: providing a first plurality of electrodes; providing a second plurality of electrodes; locating the first and the second plurality of electrodes on cranium of a subject; and supplying electric current of opposite polarities to the first and the second electrodes, wherein at least one electrode of the first plurality of electrodes is surrounded by at least two electrodes of the second plurality of electrodes .
  • Focality indicates the spatial extent of the intensity of electric field in the head and/or brain. Focality can be determined by how small the region in the brain that a significant electric field or current density is induced in by stimulation.
  • the term "about”, in the context of concentrations of components of the formulations, typically means +/- 5% of the stated value, more typically +/- 4% of the stated value, more typically +/- 3% of the stated value, more typically, +/- 2% of the stated value, even more typically +/- 1% of the stated value, and even more typically +/- 0.5% of the stated value.
  • certain embodiments may be disclosed in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the disclosed ranges. Accordingly, the description of a range should be considered to have specifically disclosed all the possible sub-ranges as well as individual numerical values within that range.
  • ranges such as from 1 to 6 should be considered to have specifically disclosed sub- ranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range.
  • FIGURE IA is a diagrammatic surface plot of the peak magnitude electric field (V/m) for a "remote bipolar" configuration
  • FIGURE IB is a diagrammatic cross-section plot of the peak magnitude electric field V/m) for a "remote bipolar" configuration
  • FIGURE 2A is a diagrammatic surface plot of the peak magnitude electric field (V/m) for a "bipolar" configuration
  • FIGURE 2B is a diagrammatic cross-section plot of the peak magnitude electric field (V/m) for a "bipolar" configuration
  • FIGURE 3A is a diagrammatic surface plot of the peak magnitude electric field (V/m) for a "belt” configuration
  • FIGURE 3B is a diagrammatic cross-section plot of the peak magnitude electric field (V/m) for a "belt” configuration
  • FIGURE 4A is a diagrammatic surface plot of the peak magnitude electric field (V/m) for a "tripolar" configuration
  • FIGURE 4B is a diagrammatic cross-section plot of the peak magnitude electric field (V/m) for a "tripolar" configuration
  • FIGURE 5A is a diagrammatic surface plot of the peak magnitude electric field (V/m) for a "ring" configuration
  • FIGURE 5B is a diagrammatic cross-section plot of the peak magnitude electric field (V/m) for a "ring" configuration
  • FIGURE 6A is a diagrammatic surface plot of the peak magnitude electric field (V/m) for a "double concentric ring" configuration
  • FIGURE 6B is a diagrammatic cross sectional plot of the peak magnitude electric field (V/m) for a "double concentric ring" configuration
  • FIGURE 7A is a diagrammatic surface normal plot of the electric field (V/m) for a "remote bipolar” configuration
  • FIGURE 7B is a diagrammatic surface normal plot of the electric field (V/m) for a "bipolar” configuration
  • FIGURE 7C is a diagrammatic surface normal plot of the electric field (V/m) for a "belt” configuration
  • FIGURE 7D is a diagrammatic surface normal plot of the electric field (V/m) for a "tripolar" configuration
  • FIGURE 7E is a diagrammatic surface normal plot of the electric field (V/m) for a "ring” configuration
  • FIGURE 7F is a diagrammatic surface normal plot of the electric field (V/m) for a "double concentric ring” configuration .
  • FIGURE 8 illustrates a triangular configuration of electrodes .
  • FIGURE 9 illustrates a concentric ring configuration of electrodes.
  • FIGURE 10 illustrates a concentric ring configuration of electrodes.
  • FIGURE 11 illustrates a 4x1 ring configuration of electrodes .
  • FIGURE 12 illustrates a pentagonal (polygonal) configuration of electrodes.
  • the electrode may be any suitable electrical appliance capable of carrying current.
  • Neurocranial stimulation is the use of electrical current to change neuronal function in the head with at least one electrode positioned on the surface of the head.
  • Neurocranial stimulation includes stimulation of the brain, the eyes, the cranial nerves, peripheral nerves in the head, sensory nerves in the head, motor nerves in the head, stimulation of structures deep in the head, stimulation of the cortex, stimulation of cortical regions, stimulation of the cerebellum, stimulation of axons of passage in the head, stimulation of the hippocampus, stimulation of the thalamus, stimulation of a combination of the above structures, and stimulation of nervous system structures that directly or indirectly connect to the above listed structures.
  • Neurocranial stimulation is distinct from applications where the primary aim is to stimulate muscle, stimulate skin, assist with drug delivery from the electrodes themselves, or measure resistance, however neurocranial stimulation may be used in conjunction with these separate approaches. Electrodes
  • the electrodes of first and second plurality of electrodes may be made of any suitable material or combination of materials capable of carrying current.
  • the electrodes may have non-conductive components.
  • the electrodes are made of materials selected from the partial group consisting of copper, aluminum, magnesium, steel, iron, carbon, graphite, silver, sponge, pad, silver chloride, sintered silver chloride, rubber, conductive rubber, gold, tungsten, titanium, ceramic, platinum, platinum- iridium, metal alloy, conductive gel, conductive fluid, polymer, conductive polymer.
  • different electrodes in the plurality of electrodes are made of different materials; for example, the first plurality of electrodes may include 2 copper electrodes and 2 silver electrodes.
  • the electrodes are Ag/AgCl electrodes made by A-M Systems, WA, USA
  • the electrodes may have any suitable size.
  • the shape of the electrode refers to the shape of the portion of the electrode in contact with the subject. More specifically, in preferred embodiments of the invention, the electrodes are located on the head or areas associated with the head of the subject, including the scalp, face, neck, ears, eyes, forehead, cheek, chin, nose, and mouth.
  • the electrodes are circular in shape.
  • the electrodes have a shape suitably selected from the group consisting of triangle, rectangle, quadrilateral, circular and polygonal.
  • the electrodes is an annular electrode with an opening.
  • the opening of the annular electrode may be of any shape suitably selected from the group consisting of circle, triangle, quadrilateral, square, pentagon, hexagon, heptagon, octagon and ellipse. In a particular embodiment the opening is circular in shape.
  • Different electrodes in the plurality of electrodes may have different shapes. Different electrodes in the plurality of electrodes may be made of different combinations of materials. In a preferred embodiment, the electrodes are circular silver disks 8 mm in diameter and having 2 mm radial width. The electrode may be commercially available electrodes fabricated for biological or non-biological applications, including EEG applications and brain stimulation applications. Electrode Fixing Means
  • the electrodes are located on the cranium of a subject.
  • Cranium is used here to refer to the whole head including the face, neck, ears, eyes, fore-head, cheek, chin, nose, and mouth.
  • the electrodes are positioned on the skin or scalp over the cranium.
  • some electrodes are positioned over the cranium and other electrodes are positioned elsewhere on the head.
  • all of the electrodes are positioned on the head in locations not directly on the cranium.
  • some electrodes are positioned on the neck.
  • some electrodes are positioned on the neck.
  • the method according to the invention may be used to stimulate any part of nervous system including but not limited to spinal cord, cerebellum, brain stem, temporal lobe, occipital lobe, parietal lobe, frontal lobe and other parts of brain and nervous system.
  • the cranial electrode positioning cap is made out of suitable material (i.e. material that is comfortable and formable and adequately robust for electrode attachment) and is designed to allow positioning of the stimulating electrodes on the head.
  • the cranial electrode positioning cap is a hood which is circular in shape.
  • the cranial electrode positioning cap is a flexible material that can take the shape of a head and it fitter with a strap.
  • the electrode positioning cap is made from mesh.
  • the electrode positioning cap is in strip form.
  • the electrode positioning cap is a band form.
  • the electrode positioning cap is a combination of stings of wires.
  • the electrode positioning cap includes a helmet.
  • the electrode positioning cap has receptors for positioning one or more stimulating electrodes.
  • the stimulation electrodes are fixed in the cranial electrode positioning cap.
  • the electrodes may be attached to the cranial electrode position cap.
  • the electrode positioning cap is customized to individuals.
  • the electrode positioning cap is fitted with sensors.
  • the electrode positioning cap is fitted with metal components.
  • the electrode positioning cap is fitted with plastic components
  • the electrode positioning cap is positioned around the neck.
  • the electrode positioning cap is held in place by an external manipulation of fixing system.
  • the electrode positioning cap is a made of MRI safe material.
  • the electrode positioning cap is made of one or more clips.
  • Each electrode is connected to a source of electrical current.
  • Term Source is used here to mean a source of electric current that can provide electric current of both polarities. Electrodes of a given plurality may be connected to the same electrical current source or they may be connected to separate current sources . Electrodes of first and second plurality are provided with electric current of opposite polarities. In one embodiment, the first plurality of electrodes is provided with electric current of positive polarity while the second plurality electrodes are provided with electric current of negative polarity. In another embodiment, the first plurality electrodes are provided with negative polarity current and the second plurality are provided with positive polarity current. The magnitude of current provided to the first and the second pluralities may be equal.
  • first and the second pluralities are provided with electric current of opposite polarities, it may be viewed as supply and withdrawal of electric current. Accordingly, one may imagine that the first plurality of electrodes is pushing current into the cranium while the second plurality is withdrawing current from the cranium. In another embodiment, the second plurality may supply the current and the first plurality may withdraw the current.
  • the electric current may be provided by any suitable source of electric current.
  • the source of current may be current controlled, or voltage controlled, or charge controlled, or capacitive, or triggered, or adaptive, or programmable, or high- resistance, or low resistance, or feed-back controlled or a combination, or a variation of these.
  • the magnitude of electric current provided to the electrodes is selected from the group consisting of 0.001 to 100 inA, 0.1 to 100 ⁇ iA, 1 mA to 100mA, 2 mA to 50 raft, In a particular embodiment electric current of 1 mA is provided to the electrodes . In another embodiment a current of 2 mA is provided. In yet another embodiment 3 mA is provided to the electrodes.
  • the electric voltage applied across the electrodes is selected from the group consisting of 0.001 V to 1 V, 0.001 V to 10 V, 0.1 V to 100 V, 1 V to 100 V and 1 V to 1000 V.
  • the current may be fixed over time or the current may change over time. For each electrode and for a combination of electrodes the total current or the total voltage or both may be limited. The current may change similarly for each electrode, or may change independently at each electrode. The current may be zero during a portion of time.
  • the current at one electrode may vary depending on the current at the other electrode. For example the current at one electrode may be a fraction of the current at another electrode or a multiple of a current at another electrode. The current at one electrode may similarly depend on the current at a combination of other electrodes.
  • the current at one electrode may be the sum of current at other electrodes.
  • the source of current may be monophasic, biphasic, charge balanced, charge imbalanced, AC, DC, sinusoidal, triangular, square, pulsed, pulse train, low-frequency, high-frequency, amplitude modulated, or a combination of these.
  • the current may be ramped up at the start of stimulation and ramped down at the end of stimulation.
  • the current may be controlled by the subject or by the device operator or by both.
  • a first electric current provided to the first plurality of electrodes may be divided before it reaches an individual electrode in the first plurality of electrodes.
  • a total current of Il provided by the first electric source may be divided into 12, 13 and 14.
  • Three different electrodes in the first plurality may be provided with currents 12, 13 and 14 respectively.
  • the division of current may be an equal division or it may be any other suitable division.
  • the total amount of current of one plurality or the division of current between electrodes of a single plurality may vary over time.
  • the total amount of current of one plurality or the division of current between electrodes of a single plurality may vary depending on a user defined variable.
  • the total amount of current of one plurality or the division of current between electrodes of a single plurality may vary depending on the condition of the electrodes, positioning of the electrodes, condition of the subject, or desired stimulation outcome.
  • the current divided into three electrodes 17, 18, and 19 may vary depending the resistance of each electrode.
  • the total current provided to the first plurality and the second plurality of electrodes is equal in magnitude.
  • the concept may be explained by analogy to water current. Just like water could be pumped into a tank and pumped out of the tank, electric current may be pushed into and pulled out of cranium. In the method according to the invention, the total current pushed into cranium of a subject and total current pulled out of the cranium are equal. Either of the first and the second current could be viewed as the current being pushed in.
  • the electrodes used for neurocranial stimulation may be arranged in many suitable configurations.
  • the electrodes are arranged in a manner that at least one electrode of the first plurality of electrodes is surrounded by at least two electrodes of the second plurality of electrodes.
  • the concept of surrounding basically excludes any co-linear configurations of electrodes where two electrodes of second plurality are located on same side of one electrode of the first plurality of electrodes.
  • two electrodes say A & B, surround a third electrode, C, if they are located on opposite sides of the third electrode.
  • electrodes A and B are located on opposite sides of electrode C.
  • Triangular Configuration Surrounding of electrodes may be achieved by various configurations.
  • the electrodes are arranged in a triangular configuration.
  • the first plurality of electrodes includes at least one electrode while the second plurality of electrodes includes at least three electrodes.
  • the three electrodes of the second plurality form three vertices of an imaginary triangle while one electrode from the first plurality is located inside the imaginary triangle.
  • Fig. 8 illustrates a triangular configuration of electrodes. Concentric Ring configuration
  • the electrodes may be arranged in a concentric ring configuration.
  • the first plurality includes one electrode and the second plurality comprises of one ring shape electrode.
  • the one electrode of first plurality is located inside the perimeter of the ring shape electrode of the second plurality of electrodes.
  • Fig. 9 illustrates a concentric ring configuration of electrodes.
  • the electrode comprising the first plurality may itself be a ring shaped electrode. Double Concentric Ring configuration
  • the electrodes may be arranged in a double-concentric ring configuration.
  • the first plurality includes one electrode and the second plurality includes two ring shape electrodes.
  • the one electrode of first plurality is located inside the perimeter of at least one ring shape electrode of the second plurality of electrodes.
  • Fig. 10 illustrates a concentric ring configuration of electrodes . 4x1 Ring Configuration
  • the electrodes may be arranged in a 4x1 ring configuration.
  • the first plurality includes one electrode while the second plurality includes four electrodes.
  • the one electrode of first plurality is located inside an imaginary quadrilateral formed by the four first plurality electrodes.
  • Fig. 11 illustrates a 4x1 ring configuration of electrodes.
  • the electrodes may be arranged in a 3x3 configuration.
  • the first plurality includes three electrodes while the second plurality also includes three electrodes. There are multiple ways to form a 3x3 configuration.
  • one electrode of the first plurality is located inside an imaginary triangle formed by the three second plurality electrodes.
  • the three electrodes of each of the first and the second plurality are arranged in collinear manner.
  • the linearly arranged electrodes may be placed in parallel stripes.
  • the linearly arranged electrodes may be placed in intersecting stripes.
  • the 3x3 electrodes may form two imaginary triangles wherein one triangle is enclosed in the second triangle. In another embodiment, the two imaginary triangles partially overlap.
  • the spatial location of the 3x3 electrodes is suitably selected depending on the area of cranium to be stimulated. 4 x 4 Configurations
  • the electrodes may be arranged in a 4x4 configuration.
  • the first plurality comprises of four electrodes while the second plurality also comprises of four electrodes.
  • one electrode of the first plurality is located inside an imaginary quadrilateral formed by the four second plurality electrodes.
  • the four electrodes of each of the first and the second plurality are arranged in collinear manner.
  • the linearly arranged electrodes may be placed in parallel stripes .
  • the linearly arranged electrodes may be placed in intersecting stripes.
  • the 4x4 electrodes may form two imaginary quadrilaterals wherein one quadrilateral is enclosed in the second quadrilateral. In another embodiment, the two imaginary quadrilaterals partially overlap.
  • the spatial location of the 4x4 electrodes is suitably selected depending on the area of cranium to be stimulated.
  • Polygonal Configuration In another embodiment, the electrodes may be arranged in a polygonal configuration.
  • the first plurality comprises of one electrode while the second plurality comprises of five or more electrodes.
  • the one electrode of first plurality is located inside an imaginary polygon formed by the second plurality electrodes.
  • Fig. 12 illustrates a pentagonal (polygonal) configuration of electrodes.
  • a method for neurocranial electrostimulation comprising: providing a first plurality of electrodes comprising at least one electrode; providing a second plurality of electrodes comprising at least one annular electrode having an opening; locating the first and the second plurality of electrodes on cranium of a subject; and supplying electric current of opposite polarities to the first and the second plurality of electrodes, wherein at least one electrode of the first plurality of electrodes is located within the opening of at least one annular electrode of the second plurality of electrodes.
  • the method of neurocranial electrostimulation according to the invention may be used to treat a mammal suffering from a nervous system related ailment. Accordingly, there is provided a method of treating a human being suffering from a brain related ailment, the method comprising: providing a first plurality of electrodes; providing a second plurality of electrodes; locating the first and the second plurality of electrodes on cranium of a subject; and supplying electric current of opposite polarities to the first and the second plurality of electrodes, wherein at least one electrode of the first plurality of electrodes is surrounded by at least two electrodes of the second plurality of electrodes.
  • the method of treatment according to the invention may be used to treat an ailment selected from the group consisting of depression, movement disorder, Parkinson's disease, epilepsy, memory loss, stroke, obsessive compulsive disorder, sleep disorder, mood disorder, schizophrenia, manic disorder, attention deficit disorder, attention deficit hyper-activity, disorder, pain, chronic pain, tumor, carpal tunnel syndrome, coma, persistent vegetative state, Creutzfeldt-Jakob disease, narcolepsy, dyslexia, head injury, migraine, prion diseases, dementia, and neurological manifestations of AIDS.
  • the method of neurocranial stimulation is used to enhance cognitive performance of a human being.
  • the cognitive performance task may be selected from the group consisting of a memory task, a speaking task, a fluency task, a sleep task, a sleep/wake task, a recognition task, a selection task, a motor task, an attention task, a reasoning task, a focus task and an understanding task, reaction time, general intelligence, a perception task, and decision tasks.
  • the method of neurocranial stimulation may be applied in conjunction with a drug.
  • a subject is administered with a drug and then subject to electrostimulation.
  • the stimulation is applied in conjunction with a drug or pharmaceutical agent.
  • the drug may be administered before, during, or after stimulation or following a specific temporal relationship relative to stimulation.
  • the drug may cancel, buffer, augment, modulate, or alter the effects of stimulation.
  • the stimulation may cancel, buffer, modulate, or alter the effects of the drugs.
  • the stimulation may be used to regulate the rate or degree of drug action over time.
  • the drug may be administered through multiple means including, but not limited to, orally, systemically, through a pump, or trans-dermaly .
  • Example Neurocranial Electrostimulation (NCS) method according to the invention is demonstrated below.
  • the TES method of the present invention enhances focality of the electric current inside cranium of a subject.
  • Neurocranial Electrostimulation induced electric fields are calculated using a four layer concentric spheres model of the human head. These layers represent the scalp, the skull, the cerebrospinal fluid, and the brain.
  • the electric field normal to the brain surface is a useful indicator of effectiveness of neurocranial stimulation.
  • the electric field normal to the brain surface was determined in this work. Further, the second derivative of the electric field is an indicator of activation.
  • the head model was treated as a 3-D inhomogeneous medium containing concentric spheres; each sphere was homogeneous and isotropic.
  • the four layer concentric model is widely used and accepted for its quantitative agreement with a variety of general observations of the electroencephalogram.
  • Four concentric zones each with uniform conductivities of 61.53 mm, 64.03 mm, 71.76 mm, and 76.49 mm radii represent the brain tissue, the cerebrospinal fluid, the skull, and the scalp respectively.
  • the electrical properties of the four layers of the model were taken from standard sources 17. The dimensions of the head are based on a 26 year old male 16.
  • the electrode configurations modeled were: "Remote bipolar”: Simulation with two electrodes (active and reference) .
  • the active electrode was placed over CZ in accordance with the 10-20 EEG system and the reference electrode at the forehead above the contralateral orbita to model the transcranial stimulation of the primary motor cortex.
  • C3 and CZ refers to electrode positions on cranium of a subject.
  • the position names are in accordance with standard naming convention accepted in the technical field.
  • Belt Simulation with the reference electrode consisting of a belt (2 mm) wide, circling the forehead with the active electrode placed on C3.
  • Tripolar Simulation with two active electrodes: first electrode over C3, and second electrode over CZ, and the reference electrode placed over the forehead above the contralateral orbita.
  • Concentric Ring Simulation with (an active electrode of outer diameter: 11 mm and inner diameter: 9 mm enclosing the reference electrode) over C3.
  • all the electrodes used in the model were circular disks 8 mm in diameter as have been used clinically 4, and having radial width 2 mm.
  • the electrodes were modeled as conductors with the conductivity of copper (5.8 X 107 S/m) .
  • the injected current had 1 mA amplitude to model the "remote bipolar" stimulation and for all other configurations the injected current density was adjusted to obtain surface plots of normal electric field of similar peak magnitudes.
  • FEMLAB 3.2 (from COMSOL Inc., Burlington, MA) was used to solve the finite element models. The model was meshed into more than 170,000 quadratic elements and more than 27000 boundary elements for each of the simulations. This provided a compromise between accuracy of the solution and processing time.
  • “Surface plots” were generated by plotting the normal electric field (to the surface) on the top half of the innermost sphere in the model (i.e. brain) .
  • Cross-section plots were generated by plotting the normal electric field, sliced through the sphere centers including the center of the active electrode. In the case of "tripolar" stimulation (where there was no radial symmetry) , the cross-section plots included the centers of one of the two active electrodes and the reference electrode.
  • the electrode was not altered, but a conductive material was added, contacting the electrode, with the above geometries.
  • insulating or grounding material was used around either the electrode of conductive materials.
  • the current distribution to each electrode was altered.
  • electrodes were grounded or connected together.
  • Fig.2A is a diagrammatic surface plot of the peak magnitude electric field (V/m) for a bipolar configuration. Consistent with previous studies, we found that with "remote bipolar” stimulation, the current density decreases much less rapidly with depth and stimulates a wider region than does “bipolar” stimulation. See Fig. IB and Fig.2B which are, respectively, a diagrammatic cross-section plot of the peak magnitude electric field (V/m) for a remote bipolar configuration and a diagrammatic cross sectional plot of the peak magnitude electric field (V/m) for a "bipolar” configuration .
  • Belt stimulation is not only less focal than "remote bipolar” stimulation, but requires more total current (Fig. 3A). As expected the electric field lines are radially distributed on the surface as they flow from the active electrode to the surface circumscribed by the reference electrode.
  • Tripolar stimulation was found to have similar region of influence (Fig.4B) as “bipolar” stimulation, but needed more total current, but less current density (since current was divided across two active electrodes) .
  • FIGURE 6A is a diagrammatic surface plot of the peak magnitude electric field (V/m) for a "double concentric ring” configuration.
  • the “surface” plots and the “surface normal” plots of both the “ring” and “double concentric ring” configurations are similar.
  • FIGURES 5A and 7E which are, respectively, again a diagrammatic surface plot of the peak magnitude electric field (V/m) for a "ring” configuration, and a diagrammatic surface normal plot of the electric field (V/m) for a "ring” configuration.
  • FIGURES 6A and 7F are, respectively, a diagrammatic surface plot of the peak magnitude electric field (V/m) for a "double concentric ring” configuration, and a diagrammatic surface normal plot of the electric field (V/m) for a "double concentric ring” configuration.
  • "Surface” plots and “surface normal” plots are one example allowing targeting of specific anatomical and functional structures.
  • Double concentric ring is, in addition to a novel geometry, an application of a combination of multiple electrodes and designs. Since the static field approximation in our model implies conservation and linearity of the electric field solution, different surface normal electric field values can be extrapolated for any current magnitude from our results by simple scaling. Similarly, if current magnitudes change over time (temporal waveform) the model can be used to determine the current/voltage distribution at any given time.
  • Electrodes were position in locations corresponding to the face, the neck, the ears, the eyes, the scalp, and the nose. It was found that by selection the electrode position, the targeting and the focality of stimulation could be controlled.
  • Electrode geometries can be used to control stimulation focality.
  • the number of electrodes used can be used to control stimulation focality.
  • the current destitution to electrodes used can control stimulation focality.
  • the use of conductive or insulation material can control stimulation focality.
  • the combination of these can define a stimulation configuration.
  • FEM solvers can be used to predict focality.
  • a region of the brain of interest may be stimulated using the appropriate stimulation configuration involving electrode geometry, number of electrodes, current distribution, and material properties used.
  • Multiple regions of the brain may be stimulated in sequence or concurrently through combination of appropriate stimulation configuration involving electrode geometry, number of electrodes, current distribution, and material properties used.
  • Any temporal waveforms to any combination of electrodes may be used with any given configuration including changing current distribution to each electrode over time or setting current to one or more electrodes to zero.
  • the geometry suggested above may be used in combination and multiple electrodes with any combination of geometries.
  • the focality may be estimated by combination of the previous results and through novel analysis using similar techniques.
  • the geometry and the current distribution of the electrodes were altered to target structure superficial in the head.
  • the geometry and current distribution were altered to target deep brain structures and structures in the mid-brain.
  • the geometry and current distribution was altered to target specific fibers bundles, axonal tracts, or fibers of passage.
  • the geometry and current distribution of the electrodes were altered to target cells with specific geometries.
  • One simulation configuration can be used and then another configuration followed by a delay in time.
  • Controlling the current to target a specific brain region or structure • Controlling the current to target a specific neurological disorder, cognitive function, or performance function.
  • a drug is administered in conjunction with electrostimulation with the following results: the drug act in conjunction with the stimulation, the stimulation controls the release or targeting of the drug, or the stimulation and drug have different actions.
  • the drug stimulation accelerated the action of the drug.
  • the drug modulates the effects of the simulation.
  • the stimulation buffered the effects of the drug.
  • the drugs buffered the effects of stimulation.
  • the metal is a mesh. In another example the metal is a solid plane. In yet another example the metal has a three dimensional surface.
  • the electrodes have a shape of circle, triangle, rectangle, pentagon, hexagon, heptagon, octagon, ellipse, strip or annulus . In one embodiment all the electrode have the same shape. In another embodiment the electrodes have different shapes.
  • an extra-cephalic electrode is positioned on the body.
  • an electrode of one plurality is portioned in an extra- cephalic location and electrodes of another plurality are positioned on the head.
  • the head positioning cap can accommodate 1 to 500 electrodes. In another example, the head positioning cap can accommodate 3 to 200 electrodes. In yet another example, the head position cap can accommodate up to 700 electrodes.
  • the electrical control includes an electrical circuit.
  • the electrical controller may be controlled by a user or by an automatic system. In one embodiment, the electrical controller controls the current delivered to each electrode .
  • a focal—localized or functionalized — neurocranial electrostimulation system and method are taught.
  • One embodiment of the method includes using multiple electrodes, with the current or voltage at each electrode controlled independently.
  • Increasing focality refers to any controlled change or changes in the spatial distribution of the current, voltage, or function of the current or voltage, in any part(s) of the head or body.
  • the shape, geometry, or material properties of the electrodes, or of materials attached or adjacent to the electrodes are modified.
  • Changing the geometry/shape of the electrodes refers to altering the configuration of the intrinsic shape of the NCS electrodes in terms of their relationships between lines, angles, and surfaces to give it a different form.
  • the electrode resistance may be suitably monitored before stimulation, during or after stimulation. In one embodiment the electrode resistance is monitored during stimulation. In another embodiment, the electrode resistance is monitored after stimulation. In a further embodiment, combined resistance of multiple electrodes is monitored. In a further embodiment, the parameters of stimulation are adjusted based on the electrode resistance.
  • One electrode of the first or second polarity is positioned in a way to stimulate a brain region selected from a group consisting of cortex, white matter, grey matter, cerebellum, cranial nerves, motor regions, prefrontal cortex, temporal lobe, sensory nerves, hippocampus, thalamus, basal ganglia.
  • the positioning of the electrodes in a appropriate fashion would activate specific brain regions.
  • the center electrode in the 4x1 configuration is positioned over the target region.
  • electrodes of a specific polarity are positioned near the target region.
  • stimulation is applied during a memory task, a speaking task, a fluency task, as sleep task, a sleep/wake task, a recognition task, a selection task, a motor task, an attention task, a reasoning task, an attention task, a focus task, an understanding task, reaction time, a commercial task, a military task, a targeting task, general intelligence, a perception task, or a decision tasks.
  • stimulation is applied to an individual with symptoms associated with depression, movement disorder, Parkinson's disease, epilepsy, memory loss, stroke, obsessive compulsive disorder, sleep disorder, mood disorder, schizophrenia, manic disorder, attention deficit disorder, attention deficit hyperactivity, disorder, pain, chronic pain, tumor, carpal tunnel syndrome, coma, persistent vegetative state, Creutzfeldt-Jakob disease, narcolepsy, dyslexia, head injury, migraine, prion diseases, dementia, or neurological manifestations of AIDS.
  • stimulation is applied to induce a change in brain function including increasing excitability, decreasing excitability, change synaptic processing, changing neuronal firing rate, changing inhibitory function, changing excitatory function, decreasing synchronization, increasing synchronization, changing neuronal timing, triggering action potentials, inducing synaptic plasticity, changing brain oscillations, or changing sleep/wake related activity.

Abstract

La présente invention concerne un procédé et un appareil destinés à améliorer la focalité de l’électrostimulation neuro-crânienne, incluant les étapes suivantes : apport d’une première pluralité d’électrodes avec au moins une électrode; apport d’une seconde pluralité d’électrodes avec au moins deux électrodes; positionnement de la première et de la seconde pluralité d’électrodes sur le crâne d’un sujet et apport d’un courant électrique de polarités opposées à la première et à la seconde pluralité d’électrodes. Au moins une électrode de la première pluralité d’électrodes est entourée d’au moins deux électrodes de la seconde pluralité d’électrodes. L’amélioration de la stimulation focale peut être utilisée pour traiter des affections ou augmenter la performance cognitive. L’invention porte également sur des procédés permettant de traiter des affections cérébrales et d’augmenter les performances.
PCT/US2008/010849 2008-04-15 2008-09-18 Appareil et procédé d’électrostimulation neuro-crânienne WO2009128810A1 (fr)

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